Obamacare’s male/female ratio is out of whack

The majority of people signing up are women

By

JonnelleMarte

Women love Obamacare.

The majority (55%) of the 3.3 million people who have signed up for insurance on the state and federally run insurance exchanges are female, according to enrollment figures released by the Department of Health and Human Services on Wednesday. That’s up one percentage point from the end of December. “It’s not something that we expected initially,” says Dan Mendelson, chief executive of Avalere Health, a health-care advisory firm based in Washington, D.C.

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The debate over whether the mix of people signing up for private insurance plans would force issuers to raise insurance rates has largely centered around the age and health of the customers buying coverage. Issuers need a good mix of young and healthy people buying coverage to help them pay for costs incurred by older and sicker customers. But women are generally more expensive to cover than men. Does that mean more men need to sign up for private insurance plans on the new exchanges to keep premiums from skyrocketing?

That will depend on the age of the women signing up, says Larry Levitt, senior vice president at the Kaiser Family Foundation. While women generally require more medical spending when they’re younger, largely because of maternity related costs, they become less expensive to cover than men in old age, says Levitt. Indeed, according to a June 2013 study by the Society of Actuaries, starting in their 20s, women are typically more expensive to cover than men, since health spending tends to increase rapidly for women during the years they are more likely to have a child. Starting at around age 61, however, men become more expensive. (Researchers said they could not explain why that shift happens later in life.)

Starting in 2014, being a woman is no longer a pre-existing condition in the health insurance marketplace.
Kathleen Sebelius, Health and Human Services Secretary

Since insurance companies can no longer charge women higher insurance premiums than men, those spending patterns would suggest that insurance companies may have to raise premiums overall if they end up covering a population made up mostly of young women, says Levitt. However, if most of the women signing up for insurance so far are older, the feminine tilt of the gender breakdown may have little impact on premiums.

However, if most of the women who sign up for insurance are older, the feminine tilt of the gender breakdown may have little impact on premiums. As of the end of January, the women signing up for insurance on the federally run marketplace were slightly older than the men: only 24% of the women were ages 18 to 34, compared with 26% of the men. And 55% of the women were at least 45 years old, compared with 52% of the men.

Of course, it’s not altogether surprising that women are enrolling in Obamacare plans in strong numbers. Prior to the Affordable Care Act, when insurance premiums could vary by gender, women were generally charged higher rates than men. The law also made it so that certain preventive health benefits, such as annual gynecological exams and birth control medication, must be covered at no additional cost. “Starting in 2014, being a woman is no longer a pre-existing condition in the health insurance marketplace,” declared Health and Human Services Secretary Kathleen Sebelius last month.

With a month and a half left in the enrollment period, the gender breakdown could still change, says Mendelson. “The big question is what will happen in the next couple of months,” he says. And insurance rates will ultimately be set not by the overall age and gender breakdown of the people buying insurance, but how much consumers end up using their medical insurance, says Levitt.

Government officials said Wednesday that they expect a surge of people to sign up for insurance at the end of the enrollment period, as the March 31 deadline for selecting a plan creates urgency among young and healthy consumers to sign up for coverage. To meet the enrollment projections set by the Congressional Budget Office—that six million people would buy private insurance plans this year—the number of people enrolled would need to roughly double between February and March.

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